MYOCARDIAL INFARCTION EQUIVALENTS 심근경색 등

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1. Posterior Myocardial Infarction

Posterior myocardial infarction is suggested by the following changes in V1-3: horizontal ST depression, tall and broad R waves (≥30ms), upright T waves, and a dominant R wave (R/S ratio ≥1) in V2. A posterior ECG or 15-lead ECG may be helpful to identify posterior wall involvement.
2. Left Main Coronary Artery Occlusion

Left main coronary artery occlusion is characterized by widespread horizontal ST depression, most prominent in leads I, II and V4-6, with ST elevation in aVR ≥1mm and ST elevation in aVR ≥V1.
3. De Winter's T Waves

De Winter's T waves suggest a proximal LAD lesion and are characterized by tall, prominent, symmetric T waves in the precordial leads, upsloping ST segment depression ≥1mm at the J-point in the precordial leads, and absence of ST elevation in the precordial leads. ST segment elevation (0.5mm-1mm) may be present in aVR.
4. Wellens' Syndrome

Wellens' syndrome represents a critical stenosis of the LAD and requires PCI in the next 24-48 hours. It is characterized by deeply-inverted or biphasic T waves in V2-3, an isoelectric or minimally-elevated ST segment (≤1 mm), and absence of precordial Q waves with preserved R waves. There are two T wave characteristics: Type A (biphasic pattern, 25%) and Type B (deeply inverted and symmetric T-waves, 75%).

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1. Posterior Myocardial Infarction

Posterior myocardial infarction (PMI) is a serious condition that occurs when the posterior wall of the left ventricle is damaged due to a lack of blood flow. This type of infarction can be challenging to diagnose, as the electrocardiogram (ECG) findings may be subtle or atypical. Early recognition and prompt treatment are crucial, as PMI is associated with a higher risk of complications, such as ventricular arrhythmias, heart failure, and cardiogenic shock. Clinicians should have a high index of suspicion for PMI in patients presenting with chest pain, particularly if the ECG shows ST-segment depression in the inferior leads or ST-segment elevation in the posterior leads (V7-V9). Diagnostic tools like echocardiography, cardiac magnetic resonance imaging, and coronary angiography can help confirm the diagnosis and guide appropriate management. Treatment typically involves prompt revascularization, either through thrombolytic therapy or percutaneous coronary intervention, along with supportive care and management of any associated complications. Ongoing research is exploring ways to improve the early detection and treatment of PMI, with the goal of reducing morbidity and mortality in this patient population.
2. Left Main Coronary Artery Occlusion

Left main coronary artery (LMCA) occlusion is a life-threatening condition that requires immediate recognition and intervention. This type of occlusion can lead to extensive myocardial damage and cardiogenic shock, with a high risk of mortality if not treated promptly. Clinicians should have a high index of suspicion for LMCA occlusion in patients presenting with acute chest pain, particularly if the ECG shows ST-segment elevation in multiple leads or a new left bundle branch block. Rapid diagnosis and treatment are crucial, as every minute of delay can significantly impact the patient's prognosis. Diagnostic tools like echocardiography, cardiac catheterization, and coronary angiography are essential for confirming the diagnosis and guiding appropriate management. Treatment typically involves emergency revascularization, either through thrombolytic therapy or percutaneous coronary intervention, along with supportive care and management of any associated complications. Ongoing research is focused on improving risk stratification, developing new therapeutic strategies, and optimizing the timing and delivery of care for patients with LMCA occlusion to improve outcomes.
3. De Winter's T Waves

De Winter's T waves are an important electrocardiographic (ECG) finding that can indicate the presence of an acute proximal left anterior descending (LAD) coronary artery occlusion. This ECG pattern is characterized by tall, symmetric T waves with slight ST-segment depression in the precordial leads (V1-V6). Recognizing De Winter's T waves is crucial, as they can be a precursor to the development of ST-segment elevation myocardial infarction (STEMI) and require prompt intervention. Clinicians should be aware of this ECG pattern and have a high index of suspicion for acute LAD occlusion in patients presenting with chest pain and these characteristic ECG findings. Rapid diagnosis and treatment, typically through emergency percutaneous coronary intervention, are essential to minimize myocardial damage and improve patient outcomes. Ongoing research is focused on improving the recognition and management of this ECG pattern, as well as exploring the underlying pathophysiology and potential therapeutic implications.
4. Wellens' Syndrome

Wellens' syndrome is a specific electrocardiographic (ECG) pattern that is associated with critical stenosis of the proximal left anterior descending (LAD) coronary artery. This syndrome is characterized by deeply inverted or biphasic T waves in the precordial leads (V2-V3), often with a history of angina and normal or minimally elevated cardiac enzymes. Recognizing Wellens' syndrome is crucial, as it can be a precursor to the development of a large anterior wall myocardial infarction if left untreated. Clinicians should be vigilant in identifying this ECG pattern and have a low threshold for further investigation, such as cardiac catheterization, to confirm the diagnosis and guide appropriate management. Prompt revascularization, typically through percutaneous coronary intervention, is the mainstay of treatment, as it can prevent the progression to a large, potentially devastating myocardial infarction. Ongoing research is focused on improving the recognition and management of Wellens' syndrome, as well as exploring the underlying pathophysiology and potential therapeutic implications.

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